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Moran S, Cheng HH, Weg E, Kim EH, Chen DL, Iravani A, Ippolito JE. Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) of prostate cancer: current and emerging applications. Abdom Radiol (NY) 2024; 49:1288-1305. [PMID: 38386156 DOI: 10.1007/s00261-024-04188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 02/23/2024]
Abstract
Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) is transforming the management of patients with prostate cancer. In appropriately selected patients, PSMA-PET offers superior sensitivity and specificity compared to conventional imaging (e.g., computed tomography and bone scintigraphy) as well as choline and fluciclovine PET, with the added benefit of consolidating bone and soft tissue evaluation into a single study. Despite being a newly available imaging tool, PSMA-PET has established indications, interpretation guidelines, and reporting criteria, which will be reviewed. The prostate cancer care team, from imaging specialists to those delivering treatment, should have knowledge of physiologic PSMA radiotracer uptake, patterns of disease spread, and the strengths and limitations of PSMA-PET. In this review, current and emerging applications of PSMA-PET, including appropriateness use criteria as well as image interpretation and pitfalls, will be provided with an emphasis on clinical implications.
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Affiliation(s)
- Shamus Moran
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Emily Weg
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Delphine L Chen
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Amir Iravani
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 4559 Scott Ave., Mail Stop Code: 8131, St. Louis, MO, 63110, USA.
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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Loeb S, Cheng HH, Paller CJ, Weg E, Johnson J, Gross L, Keith SW, Russo J, Hathaway F, Rivera A, Giri VN. Addressing gaps in healthcare provider knowledge regarding germline testing for prostate cancer through development and testing of a virtual genetics board. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00778-9. [PMID: 38172199 DOI: 10.1038/s41391-023-00778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Germline testing is important in prostate cancer and evaluation can be complex. METHODS We instituted a monthly multi-disciplinary virtual genetics tumor board (7/2021-3/2022). Participants and panelists were surveyed on usefulness and acceptability. RESULTS 101 participants attended a session, and 77 follow-up surveys were completed. Over 90% participants and 100% panelists endorsed usefulness of the case discussions and usability of the technology. The majority felt it provided new information they will use. CONCLUSIONS A multidisciplinary genetics board was successfully developed to address complexity in prostate cancer genetics. The virtual platform may enhance dissemination of expertise where there are regional gaps.
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Affiliation(s)
- Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA.
| | - Heather H Cheng
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MA, USA
| | - Emily Weg
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Jennifer Johnson
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura Gross
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Scott W Keith
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Medical Colllege, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica Russo
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, USA
| | - Feighanne Hathaway
- Hematology/Oncology, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Adrian Rivera
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
| | - Veda N Giri
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
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Chen JJ, Weg E, Liao JJ. Prostate and metastasis-directed focal therapy in prostate cancer: hype or hope? Expert Rev Anticancer Ther 2023; 23:163-176. [PMID: 36718727 DOI: 10.1080/14737140.2023.2171991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The paradigm of focal therapy's role in metastatic patients is being challenged by evolving attitudes and emerging data. At the current time, specifically regarding prostate cancer, does the evidence indicate this is more hype or hope? AREAS COVERED We searched the literature via PubMed, MEDLINE, and Embase for studies from 2014 to the present addressing focal therapy with non-palliative intent in metastatic prostate cancer patients, emphasizing prospective trials when available. We sought to address all common clinical scenarios: de novo synchronous diagnosis, oligorecurrence, oligoprogression, and mCRPC disease. EXPERT OPINION Current evidence is strongest, and in our opinion practice-changing, for prostate-directed RT in de novo metastatic patients with low metastatic burden. Metastasis-directed therapy with SBRT is consistently shown to have low rates of toxicity, and promising rates of ADT-free survival and progression-free survival. These can be utilized on a patient-by-patient basis with these endpoints in mind, but do not yet show sufficient benefit to be standard of care. This is a rich area of ongoing research, and many trials should publish in the coming years to shed light on many unanswered questions, including the role of cytoreductive prostatectomy, systemic therapy combined with MDT, and the integration of modern PET imaging.
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Affiliation(s)
- Jonathan J Chen
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Emily Weg
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Jay J Liao
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
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McKenney AS, Weg E, Bale TA, Wild AT, Um H, Fox MJ, Lin A, Yang JT, Yao P, Birger ML, Tixier F, Sellitti M, Moss NS, Young RJ, Veeraraghavan H. Radiomic Analysis to Predict Histopathologically Confirmed Pseudoprogression in Glioblastoma Patients. Adv Radiat Oncol 2023; 8:100916. [PMID: 36711062 PMCID: PMC9873493 DOI: 10.1016/j.adro.2022.100916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose Pseudoprogression mimicking recurrent glioblastoma remains a diagnostic challenge that may adversely confound or delay appropriate treatment or clinical trial enrollment. We sought to build a radiomic classifier to predict pseudoprogression in patients with primary isocitrate dehydrogenase wild type glioblastoma. Methods and Materials We retrospectively examined a training cohort of 74 patients with isocitrate dehydrogenase wild type glioblastomas with brain magnetic resonance imaging including dynamic contrast enhanced T1 perfusion before resection of an enhancing lesion indeterminate for recurrent tumor or pseudoprogression. A recursive feature elimination random forest classifier was built using nested cross-validation without and with O6-methylguanine-DNA methyltransferase status to predict pseudoprogression. Results A classifier constructed with cross-validation on the training cohort achieved an area under the receiver operating curve of 81% for predicting pseudoprogression. This was further improved to 89% with the addition of O6-methylguanine-DNA methyltransferase status into the classifier. Conclusions Our results suggest that radiomic analysis of contrast T1-weighted images and magnetic resonance imaging perfusion images can assist the prompt diagnosis of pseudoprogression. Validation on external and independent data sets is necessary to verify these advanced analyses, which can be performed on routinely acquired clinical images and may help inform clinical treatment decisions.
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Affiliation(s)
- Anna Sophia McKenney
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Emily Weg
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Tejus A. Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aaron T. Wild
- Department Southeast Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina
| | - Hyemin Um
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael J. Fox
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Lin
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan T. Yang
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Yao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maxwell L. Birger
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Florent Tixier
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Sellitti
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nelson S. Moss
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J. Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
- Corresponding author: Robert J. Young, MD
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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Psutka S, Gore J, Holt S, Dwyer E, Schade G, Grivas P, Hsieh A, Lee J, Montgomery RB, Schweizer M, Yezefski T, Yu E, Chen J, Liao J, Weg E, Zeng J, Alving T, Jannat S, Wright J. PD14-10 PROSPECTIVE EVALUATION OF A COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) IN MULTIDISCIPLINARY BLADDER CANCER CARE: FEASIBILITY AND IMPACT ON DECISIONAL CONFLICT. J Urol 2022. [DOI: 10.1097/ju.0000000000002546.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nguyen B, Mota JM, Nandakumar S, Stopsack KH, Weg E, Rathkopf D, Morris MJ, Scher HI, Kantoff PW, Gopalan A, Zamarin D, Solit DB, Schultz N, Abida W. Pan-cancer Analysis of CDK12 Alterations Identifies a Subset of Prostate Cancers with Distinct Genomic and Clinical Characteristics. Eur Urol 2020; 78:671-679. [PMID: 32317181 PMCID: PMC7572747 DOI: 10.1016/j.eururo.2020.03.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND CDK12 genomic alterations occur in several tumor types, but little is known about their oncogenic role and clinical significance. OBJECTIVE To describe the landscape of CDK12 alterations across solid cancers and the clinical features of CDK12-altered prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A single-center retrospective study of 26743 patients across 25 solid tumor types who underwent tumor sequencing was performed. Clinicopathologic features and outcomes were assessed in prostate cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS CDK12 alterations and their association with genomic characteristics are described. For prostate cancer patients, overall survival and time to castration resistance were assessed using univariable and multivariable Cox regression analysis. RESULTS AND LIMITATIONS CDK12 alterations were identified in 404/26743 patients (1.5%) overall, but were most frequent in prostate (100/1875, 5.3%) and ovarian cancer (43/1034, 4.2%), in which they were associated with a high prevalence of truncating variants and biallelic inactivation. CDK12 alterations defined a genomic subtype of prostate cancer with a unique copy-number alteration profile and involvement of distinct oncogenic pathway alterations, including cell-cycle pathway genes. CDK12-altered prostate cancer was associated with somewhat more aggressive clinical features and shorter overall survival (median 64.4 vs 74.9 mo; p=0.032) independent of standard clinical factors and tumor copy-number alteration burden (adjusted hazard ratio 1.80, 95% confidence interval 1.12-2.89; p=0.024). The study is limited by its retrospective nature. CONCLUSIONS CDK12 alteration is a rare event across solid cancers but defines a clinically distinct molecular subtype of prostate cancer associated with unique genomic alterations and slightly more aggressive clinical features. PATIENT SUMMARY CDK12 gene alterations occur rarely across tumor types, but more frequently in prostate cancer, where they are associated with genomic instability, cell-cycle pathway gene alterations, and somewhat worse clinical outcomes, warranting further investigation of therapeutic targeting of this disease subset.
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Affiliation(s)
- Bastien Nguyen
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose Mauricio Mota
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Subhiksha Nandakumar
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Konrad H Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily Weg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dmitriy Zamarin
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wassim Abida
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Nguyen B, Mota JM, Nandakumar S, Stopsack KH, Weg E, Rathkopf D, Morris MJ, Scher H, Kantoff PW, Gopalan A, Zamarin D, Solit DB, Schultz N, Abida W. Abstract 1308: CDK12 alterations define a distinct molecular subtype of prostate cancers with unique genomic and clinical characteristics. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: CDK12 alterations are present in several tumor types but little is known regarding their oncogenic role and their clinical significance. Here we sought to describe the landscape of CDK12 alterations across solid cancers and the clinical features of CDK12-altered prostate cancer.
Methods: A total of 26,743 patients across 25 solid tumor types with available targeted sequencing data from MSK-IMPACT as part of their clinical care were included. Clinicopathological features and outcomes were assessed in prostate cancer. CDK12 alterations and association with genomic characteristics are described. For prostate cancer patients, overall survival from the date of metastasis and time to castration-resistance from the start of androgen deprivation therapy were assessed using univariable and multivariable Cox regression analysis.
Results: CDK12 alterations were identified in 404/26,743 (1.5%) patients overall, but were most frequent in prostate (100/1875, 5.3%) and ovarian cancer (43/1034, 4.2%) where they were associated with a high prevalence of truncating variants and biallelic inactivation. CDK12 alterations defined a distinct subtype of prostate cancer with more aggressive clinical features, a unique copy number alteration profile and involvement of distinct oncogenic pathway alterations, including cell cycle pathway genes. Independent of standard clinical factors and genomic instability, CDK12-altered prostate cancer patients were associated with shorter overall survival (median 64.4 vs 74.9 months, adjusted hazard ratio [aHR] 1.65, 95% CI 1.07-2.53, p = 0.03) and shorter time to the development of castration-resistant disease (median 10.8 months vs 13.1, aHR 1.43, 95%CI 1.07-1.8, p = 0.02).
Conclusions: CDK12 loss of function is a rare event across solid cancers but defines a distinct molecular subtype of prostate cancer that is associated with more aggressive clinical features and unique genomic alterations.
Citation Format: Bastien Nguyen, Jose Mauricio Mota, Subhiksha Nandakumar, Konrad H. Stopsack, Emily Weg, Dana Rathkopf, Michael J. Morris, Howard Scher, Philip W. Kantoff, Anuradha Gopalan, Dmitriy Zamarin, David B. Solit, Nikolaus Schultz, Wassim Abida. CDK12 alterations define a distinct molecular subtype of prostate cancers with unique genomic and clinical characteristics [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1308.
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Affiliation(s)
| | | | | | | | - Emily Weg
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Howard Scher
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Wassim Abida
- Memorial Sloan Kettering Cancer Center, New York, NY
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Brennan VS, Weg E, Beckham T, Damato A, Grisham R, Gardner G, Kollmeier M. Clinical Outcomes for Salvage High-Dose-Rate Brachytherapy in Patients with Recurrent Endometrial Cancer. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Taggar AS, Charas T, Weg E, Kollmeier M, Zelefsky MJ. Placement of an Absorbable Rectal Hydrogel Spacer in Patients Undergoing Low-Dose-Rate Brachytherapy with Pd-103 Seeds. Brachytherapy 2017. [DOI: 10.1016/j.brachy.2017.04.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The generally prescribed procedure for choosing a decision strategy from a decision tree employs a backward induction analysis that entails 3 fundamental consistency principles: dynamic, consequential, and strategic. The first requires the decision maker to follow through on plans to the end, the second requires the decision maker to focus solely on future events and final consequences given the current state of events, and the third is the conjunction of the first 2. Five experiments were reported to test these principles using different subject populations, different procedures for estimating consistency, and different factors for manipulating the attractiveness of the gamble at the final stage of the tree. The main findings were that strategic and dynamic consistency principles were violated at rates that exceeded choice inconsistency.
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Affiliation(s)
- J R Busemeyer
- Department of Psychology, Indiana University, Bloomington, Indiana 47405, USA.
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Abstract
The generally prescribed procedure for choosing a decision strategy from a decision tree employs a backward induction analysis that entails 3 fundamental consistency principles: dynamic, consequential, and strategic. The first requires the decision maker to follow through on plans to the end, the second requires the decision maker to focus solely on future events and final consequences given the current state of events, and the third is the conjunction of the first 2. Five experiments were reported to test these principles using different subject populations, different procedures for estimating consistency, and different factors for manipulating the attractiveness of the gamble at the final stage of the tree. The main findings were that strategic and dynamic consistency principles were violated at rates that exceeded choice inconsistency.
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Affiliation(s)
- J R Busemeyer
- Department of Psychology, Indiana University, Bloomington, Indiana 47405, USA.
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